Healthcare Provider Details

I. General information

NPI: 1801918461
Provider Name (Legal Business Name): KERRY L MILLER D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 W CORONADO RD
SANTA FE NM
87505-2610
US

IV. Provider business mailing address

369 MONTEZUMA AVE 172
SANTA FE NM
87501-2626
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-1466
  • Fax:
Mailing address:
  • Phone: 505-603-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1649
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: